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Archive for the ‘COELIAC DISEASE’ Category

Adult coeliac disease:

BY: Alastair L Hepburn, consultant rheumatologist BMJ  2007;335:627 (29 September).

Coeliac disease can present in a non specific way in adults. Presentations to rheumatology services are not uncommon with symptoms including fatigue, weakness, non-specific arthralgia, muscle cramps, and myalgia.

A good argument therefore exists for screening for this disease when patients present with what may seem initially to be fibromyalgia or chronic fatigue syndrome (CFS), using combined serological testing.

If you want to read more about the PRESENTATION of COELIAC DISEASE IN ADULTS, just CLICK HERE.

PS: When he writes CFS he also means ME (Myalgic Encephalomyelitis), which is actually NOT the same as CFS.

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Delay in the diagnosis of coeliac disease prolongs morbidity and mortality.

The study by Dr Cannings-John et al in the Br J Gen Pract. 2007 Aug; 57 (541):636-42 17688758, examined with what sorts of complaints patients presented to their GP during the 5 years PRIOR to the diagnosis of coeliac disease. They looked at patients with BIOPSY-proven coeliac disease and in general it TOOK FIVE years, 4.9 to be exact, before these patients went from, there is nothing wrong with you, it is all in the mind, to having their problem diagnosed.

Interestingly enough, 90% of these patients were referred for hospital investigations either organised by their GP, or to see a consultant. Ninety four percent had blood tests done. And one in three even had an endoscopy, and still nothing was found. What was found though was, that these patients in the five years before diagnosis, consulted their GPs a lot more than healthy controls. We all know that patients most often have a pretty good idea what is wrong with them, i.e. is it a physical or a mental health problem. So we should keep this in mind when dealing with difficult problems. Or I should say, we should RECONSIDER our diagnosis if patients keep coming back. Three clinical features were independently associated with subsequent diagnosis of coeliac disease: depression and/or anxiety, diarrhoea and anaemia. But these patients also presented a lot more with common symptoms like: abdo pain, gastritis, insomnia, IBS and interestingly enough, headaches, before someone finally got the diagnosis right. The authors concluded by saying that GPs should consider testing for celiac disease when patients present often, especially with diarrhoea and/or who are discovered to be anaemic.

Again this proves the point, that frequent attenders might very well have an illness, and not a pseudo or imaginary illness, as some seem to belief. Even though in another article in the same BJGP, another author, called frequent attenders heartsink patients, and that was apparently all down to (sexual) abuse in their childhood. I will discuss that article another time.

But this celiac paper proves again that we as doctors don’t listen well enough, i.e. are not good at diagnosing. And if you don’t listen and don’t do the RIGHT test, you won’t get the DIAGNOSIS RIGHT.

So what do you need to do?? When you notice anaemia or think about coeliac, you have to request the specific coeliac blood test. To check for antibodies, and if these are present, you have to confirm the diagnosis via endoscopy performed in hospital. 

PS: I’m afraid this study is NOT available free of charge from the BJGP. If I will come across a link to the full text of this article I will put it here. But if you would like to read the extract  just click here.

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